Late last month, the DOJ announced that St. Peter’s Health agreed to pay $10.8M to settle False Claims Act allegations. The settlement resolves claims that the organization submitted inaccurate information to federal healthcare programs, including Medicare and Medicaid, for services performed and referred by oncologist Dr. Thomas Weiner. These alleged false claims primarily involved a combination of billing for services not rendered, overbilling for services, and billing for unnecessary services between January 1, 2015, and December 31, 2020. The alleged misconduct led to significant financial losses for federal healthcare programs.
The settlement agreement contends that St. Peter’s violated the False Claims Act by submitting false claims for payments to federal health care programs relating to services performed and referred by Dr. Weiner, including that St. Peter’s knew, or should have known, that Dr. Weiner submitted claims for office visits that were coded at a higher level of service than was actually performed or did not meet the requirements of a significant, separately identifiable service when performed on the same day as administration of chemotherapy. Further, St. Peter’s, relying on Dr. Weiner’s documentation and certification, compensated Dr. Weiner with a salary that was based on the false claims, and therefore, caused his salary to be inconsistent with fair market value.
The settlement agreement credits St. Peter’s for voluntarily self-disclosing the misconduct. According to the DOJ, St. Peter’s also performed and disclosed the results of an internal investigation; disclosed documents beyond existing business practices or legal requirements; identified individuals who were aware of relevant information or conduct; made officers and employees available for interviews; assisted in determining the losses caused by the misconduct; and has enhanced its corporate compliance program.
The attorneys at Chilivis Grubman represent healthcare providers of all types and sizes in connection with False Claims Act litigation and investigations. If you need assistance with such a matter, please contact us today.